The key features of ESC’s Other Health Claims adjudication system include:

Ability to differentiate between private and provincial co-ordination of benefits (COB)

Rules for provincial COB services/products

Letter generation

Ability to set COB rules at the group/subgroup, client and patient levels

Reasonable and customary pricing

Claims are adjudicated in Canadian dollars, according to program benefit rules in effect at the time services were provided or products were purchased. In addition, the system supports the reversal and resubmission of claim information, ensuring that the verification parameters in effect at the time the service or purchase occurred can be applied. This includes claim history and frequency history counters, as well as the claimed-against portion of the predeterminations for other health care benefits. The system can be customized so that edits are bypassed based on policy rules, which includes messages and frequency limitations.